Insurance Authorizations

Quick and accurate prior authorizations result in better business.

Clarity initiates all your insurance authorizations in just hours so you can schedule your patient with confidence

  • Improve authorization accuracy and timeliness

  • Lower write-offs

  • Reduce operational costs

Insurance Authorizations Chart Specialist customers report a 65 percent increase in accurate and timely authorizations with Clarity. Over 50 percent of authorizations are completed within one business day and 80 percent are completed within two days.

Referral Management

Streamline all your referrals into one, easy-to-use worklist.

View real-time status updates, return reports, and more with Clarity. Our EMR-agnostic platform can integrate with your existing technology for a customizable workflow.

  • Increase referral capture rate

  • Reduce roundabout communication

  • Optimize workflow

Referral Management Chart PCP and specialist customers report a time saving improvement of 59 percent by using Clarity.

Clarity Reporting

Referral insights and anlaytics, powered by Tableau.

What percentage of referrals turn into scheduled and completed visits? What is your turnaround time to contact patients? Track and measure referral metrics with
Clarity Reporting.

  • Gain actionable insights

  • Customize reports with data that matters to you

  • Improve transparency

Clarity Reporting Image

FAQ

What is an insurance authorization?

An insurance authorization is a decision by a patient’s health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. A patient’s health insurance or plan may require authorization for certain services before they receive them, except in an emergency. It is also called prior authorization, prior approval, or precertification. Clarity Health offers insurance authorizations associated with patient referrals, specifically health care services and treatment plans.

What is the difference between an insurance prior authorization vs. an insurance authorization?

A. There is no difference, a prior authorization and authorization are the same thing: A decision by your health insurer or plan that a health care service, treatment plan, prescription drug or durable medical equipment is medically necessary. The insurance industry interchanges different terms, but the government uses authorization as the preferred term.

How does Clarity’s insurance authorization service work?

We utilize a combination of technology and servicing to deliver quick and accurate insurance authorizations. We developed an insurance processing platform that automates insurance authorizations when possible. Because the technology capabilities of payers vary, we have a Seattle-based team of insurance authorization specialists who process referrals when necessary.

How quickly does Clarity Health deliver insurance authorizations?

We initiate all authorizations in four hours or less. Over 50 percent of authorizations are completed within one business day and 80 percent are completed within two business days. Of course, there are difficult payers that pend authorizations and can take several days to obtain a completed authorization. In those cases, we run consistent status checks and provide updated documentation for your practice.

How accurate are Clarity’s insurance authorizations?

Clarity's authorizations are extremely accurate as insurance processing is our core competency. Our expert knowledge base stays up-to-date on payer and plan changes for you, which have grown increasingly complex with the Affordable Care Act.

What information is included in Clarity's insurance authorizations?

Clarity obtains the following information for referrals:

  • Eligibility: Determining if patient’s insurance is active or not.
  • Network Status: Verifying whether the referred to physician is in or out-of-network.
  • Insurance Authorization: Determining if procedure(s) require authorization and obtaining one if it is required.

I’m a specialist. How do you obtain insurance authorizations from payers who require the referring provider to initiate it?

In this circumstance, Clarity is able to obtain authorizations on behalf of your referring provider by setting up a Business Associate (BA) agreement. This helps streamline the referral and authorization process for both parties. For authorizations sent to your practice, we double check for accuracy and make corrections if there are errors. In our experience, half of authorizations sent by referring providers contain inaccuracies.

How does Clarity’s referral management platform work?

Clarity streamlines all of your referrals into one electronic worklist for easy management. Staff members can easily view patient status updates, return reports, and authorizations. Clarity Reporting gives you actionable insights into your referral capture rate, referral patterns, and more with customizable reports.

How do referrals get entered into Clarity?

We recognize every practice has a unique referral workflow. Therefore, we offer a number of options tailored to fit your practice’s needs. Many practices enter referrals directly into Clarity, as our easy interface only takes a couple of minutes per a referral. We also offer HL7 and EMR integration for a seamless workflow with your practice’s existing system.

Can Clarity integrate with my EMR?

Yes. Our vendor-agnostic platform can integrate with major EMR vendors, a key differentiator in a market saturated with stand-alone EMRs. Interfaces typically allow practices to automate the process of sending and receiving referrals, attachments and scheduling updates. However, it is not a requirement for using the Clarity platform – it’s up to the workflow preference of each practice.

Does my practice need special software or hardware to use Clarity?

No. Clarity’s platform is web-based so there is no special hardware or software to purchase, no costly training, no maintenance fees. Our user-friendly interface is very intuitive.

How does Clarity comply with HIPAA requirements?

Clarity’s top priority is securing patient information. Ensuring that we exceed the expectations of all legal protections legislated to protect patient privacy, we have documented, rigorous, auditable security processes.

Will Clarity Health be prepared for the ICD-10 transition on October 1st, 2015?

Yes, we introduced ICD-10 codes alongside ICD-9 codes on July 1st to help our customers transition at their own speed, as insurance payer requirements may vary. For further resources, read more here.

Can Clarity help my practice meet Core Measure 15 for Meaningful Use Stage 2?

Clarity can assist Referring Practices in meeting Core Measure 15 for Meaningful Use Stage 2 (Transition of Care). To meet this measure for MU2, a Transition of Care Document (CCDA) must be sent electronically for >10% of transitions of care and referrals. The practice’s Certified EHR Technology is responsible for generating and transmitting the CCDA, and tracking the successful transmissions for CMS reporting.

The workflow for referring practices would be for a provider to send a Direct message with an attached CCDA to Clarity’s Direct mailbox*. Clarity attaches the CCDA in PDF format to a patient’s draft referrals and then proceeds with our insurance authorization services. Clarity-connected specialists can retrieve the CCDA inside Clarity at any time by opening the patient’s referral. For offline specialists, Clarity will deliver the CCDA to the specialist’s Direct mailbox using the national directory of Direct addresses.

*Clarity will allow Direct messaging from practices using a certified HISP (a member of the Direct Trust bundle). Contact us for more information

What impact will Clarity Health Services have on my staff?

By having Clarity handle authorizations, we enable your staff to better utilize their time for more productive activities. According to a Health Affairs study, practice staff spend 20 hours/week per a physician on insurance authorizations alone, costing $15-25,000 a year per physician. Staff members waste hours on hold every week with payers and practices tracking down authorizations and patient information. Clarity customers are able to reallocate that time to better focus on patients - scheduling them quicker, creating a better check- in experience, proactively managing the referral to its completion, marketing activities, etc.

How much does Clarity cost?

Clarity is a monthly subscription service with no upfront fees or long-term contracts. On a monthly basis, we charge a subscription fee per provider and a transaction fee based on referral volume and type. We created our pricing structure and per-transaction fee to accommodate your practice’s referral volume fluctuations throughout the year, ensuring you only pay for what you use. Contact us for a custom quote.